十二指肠镜联合腹腔镜治疗肝外胆管结石间隔时间的探讨

Discussion of interval time of duodenoscopy combined with laparoscopy for extrahepatic bile duct calculi

目的:探讨十二指肠镜联合腹腔镜治疗肝外胆管结石的间隔时间对临床疗效的影响。方法:选取2014年1月至2017年1月行内镜十二指肠乳头括约肌切开术(endoscopic sphincterotomy,EST)联合腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)治疗的40例肝外胆管结石患者,按EST与LC间隔时间分为A组(n=20,间隔时间≤48 h)与B组(n=20,间隔时间>48 h),对比分析两组临床效果。结果:A组总住院时间、LC手术时间、术中出血量、胆囊壁厚度优于B组,差异有统计学意义(P<0.05)。但两组术后恢复通气时间、术中放置引流管例数、胆囊化脓(含坏疽)例数等差异无统计学意义(P>0.05)。结论:EST术后48 h内行LC可缩短住院时间、手术时间,减少术中出血量,为临床EST术后行LC的间隔时间提供了参考。

Objective： To investigate the influence of interval time of duodenoscopy and laparoscopy on clinical therapeutic effect of extrahepatic cholelithiasis.Methods： From Jan. 2014 to Jan. 2017,40 patients with extrahepatic cholangiolithiasis were treated with endoscopic sphincterotomy（ EST） combined with laparoscopic cholecystectomy（ LC） and were divided into two groups according to the interval between EST and LC.There were 20 cases with interval time ≤48 h in group A and 20 cases with interval time 48 h in group B,the clinical effect of the two groups were compared. Results： Compared with the group B,in the group A total hospitalization time and the operation time of LC were shorter,the amount of intraoperative bleeding was less and the thickness of the gallbladder wall was smaller（ P0.05）.However,there were no significant differences in postoperative exsufflation time,number of drainage tube placed in operation or gallbladder suppuration（ including gangrene） between the two groups（ P0.05）.Conclusions： LC within 48 h after EST can shorten the time of hospitalization and operation,reduce the amount of bleeding in the operation,and provide reference for the interval of EST and LC in clinic.